Sixty pages into The Hospital Suite, cartoonist John Porcellino is already grappling with his own mortality. He’s taken a few spills, is dizzy and can’t keep food down. His bones are visible through his skin. In a few well-placed lines, the artist perfectly captures his own deathly visage peering back in a bathroom mirror. The words “I’m dying” appear in a thought bubble above his head. A few pages later, after another unfruitful trip to the hospital, he’s back at the mirror when he hears a clinking sound in the sink porcelain below, as his wedding ring falls from his finger because of his rapid weight loss.

“When I got out of the hospital, I had splurged and bought all of these books, and one of them was Our Cancer Year,” Harvey Pekar’s beloved 1994 autobiographical comic, Porcellino explains by phone. In it, Pekar recounted a story remarkably similar Porcellino’s own wedding ring experience. “I was reading it and I was like, ‘Damn! Pekar beat me to it!’ As soon as it rolled under the sink, I knew it was going to be in the comic. It was a really important thing that happened. I knew I would just put the story in there and I would have to put the story about reading Our Cancer Year in there as well.”

True to his word, both stories made it into The Hospital Suite, a book length recounting of years worth of health struggles out later this month from Drawn & Quarterly. Porcellino is best known for his mini-comix, published as King Cat Comix. His minis are often simple koan-like meditations on life. The Hospital Suite is a fairly unique one in the beloved and devotedly independent cartoonist’s catalog, not just for its relatively long length, clocking in at 250 pages, but for the manner with which Porcellino approached the extremely personal—and often scary—subject of his own wavering health. This year marks the 25th anniversary of Porcellino’s King Cat series — which makes the series a fairly strong contender for the title of the longest running self-published mini-comic.

But The Hospital Suite was a long time in the making. “I drew it last year,” Porcellino told PWCW. “It was very satisfying to finally sit down and finally draw out the scene that was in my head for 16 years. I’ve always know for all these years—assuming I survived—that I was going to write this scene, the one where it falls off and the scene where I get mad. That was very satisfying to put it down on paper.”

In spite of the artist’s long-standing openness to discussing personal issues in the series, Porcellino has largely avoided the topic of the health battles that landed him in hospital bed numerous times over the years. “I kind of obliquely referenced this stuff here and there in King Cat,” he explains. “Obviously my really good friends were privy to that stuff, I kind of kept it quiet a little bit. I’m not really sure why, because I’m kind of open to discussing whatever in my comics. I think in a weird way, I didn’t really know where my health issues were going.”

In the book, Porcellino’s agonizing pain is unable to be diagnosed for months, leading to the weight loss. Other sections of the book deal with his other health and diet issues and his struggle with OCD.

While he knew all along that the stories would eventually make their way onto one of his characteristically minimalist comics pages, but from his first hospital stay in the late 90s to this year’s publication of the book, the process took nearly two decades. “I have the notebook from when I was first hospitalized in 1997 and got home and instantly wrote out a synopsis,” the cartoonist adds. “I made a little calendar with the dates of surgeries and tests. I knew somewhere down the line that I would probably make a comic of this. So it took 17 years to finish it, but that’s how it is with comics.

“When I was in the midst of this stuff, I had no idea what was going to happen,” he continued. “I was more concerned about making it to the weekend than turning it into a comic. To me it was a paradox a little bit. Usually in my comics I’m willing to leave the end hanging, and many of them end with no clear conclusion or direction. That’s a choice that I make artistically because life often doesn’t have clear-cut endings or conclusions. It doesn’t get tied up in a neat little bow.”

In recent years, Porcellino’s conditions have improved to the point where he’s felt comfortable enough to travel again, taking part in the ever-growing number of independent comics shows across the country and world that are playing growing role in the abilities of small press cartoonists to make a living with their art. This month, the artist will find himself celebrating his 46th birthday at the Small Press Expo (SPX) in Bethesda, Maryland, an event that will also serve as the celebration of King Cat’s 25th anniversary, the premiere of the Kickstarter-funded Porcellino documentary Root Hog or Die and the debut of The Hospital Suite.

The book is also the cartoonist’s most ambitious self-contained work to date. “It feels really good to have just gotten it out of my system,” says Porcellino. “The book is three individual stories, which definitely tell a complete narrative but they definitely overlap. Originally my thought was to do three small novellas. But I didn’t want to be the guy who every year puts out a new book about all of the terrible things that happen to him. And for myself, I just wanted to deal with it all in comics form, get it out there and move on.”

Twenty-five years into King Cat’s existence, Porcellino still has plenty to move on to, including issue 75 of his beloved zine as well as a continued focus on longer pieces. “I still have a couple more collections under my belt that we could put out,” he says of future projects. “And I’ve got a handful of longer stories that I’ve been working on for quite a while in pieces here and there. They’re more appropriate for a longer form work, and I think that’s what [I’m] going to focus on, more longer work like The Hospital Suite.”